2019;213: 234-237. Some non-North American radiologists think that AJR stands for the American Journal of Radiology; however, it has always been short for the American Journal of Roentgenology, or a close variant of this. In all instances of unsuccessful clip deployment, the collagen pledget was visible in the mouth of the biopsy handpiece after its removal; therefore, failure of clip deployment was immediately apparent to the radiologist performing the biopsy. A T1-weighted 3D fat-suppressed fast spoiled gradient-echo sequence (17/2.4; flip angle, 35°; bandwidth, 31.25 MHz) was then performed before and three times after a rapid bolus injection of 0.1 mmol/L of gadopentetate dimeglumine (Magnevist, Berlex, Wayne, NJ) per kilogram of body weight, delivered through an indwelling IV catheter. Although it remains controversial, excision may also be warranted for lesions yielding LCIS at percutaneous biopsy . Frequency was in the anteroposterior direction. Two lesions were posterior to the biopsy compression grid. The clip was evident as a low-signal focus measuring a median of 0.6 mm (range, 0.4–0.6 mm). Compression with ice after biopsy followed by a pressure dressing may be helpful in this regard. Twenty women scheduled for MRI-guided needle localization and surgical excision were prospectively asked to participate in this study. After tissue acquisition was complete, the biopsy device was removed, the obturator was reinserted, and sagittal T1-weighted images (3-mm slice thickness), the postexamination images, were obtained to assess the completeness of tissue acquisition. The impact factor (IF), also denoted as Journal impact factor (JIF), of an academic journal is a measure of the yearly average number of citations to recent articles published in that journal. In one smooth mass that yielded fibroadenoma at vacuum-assisted biopsy, a mammogram obtained after biopsy showed that the clip was 4.0 cm deep (medial) in relation to the lesion. Dibandingkan dengan Faktor Dampak historis, Faktor Dampak 2019 dari American Journal of Roentgenology turun 3.92 %. Further work characterizing MRI patterns of specific benign and malignant lesions is necessary. We thank the 20 women who enrolled in the study for making this work possible. Vacuum-assisted biopsy and surgical histology were correlated. For MRI-detected lesions warranting biopsy that had neither mammographic nor sonographic correlates, MRI-guided localization and surgical excision were performed . In the latter three lesions, the distances from the clip to the wire were 3.4, 4.0, and 4.1 cm, respectively; all three clips were deep (medial) in relation to the localizing wires. Get Content & Permissions Free. Resistance was felt when the clip touched the end of the “mouth,” indicating that it had reached the appropriate depth. Our goal was to use DL to accelerate MRI … The biopsy was technically successful in 19 (95%) of 20 women. A lesion was considered to be cancer if cancer was found at vacuum-assisted biopsy, surgical excision, or both. The breast undergoing localization was placed in a dedicated biopsy compression device using a commercially available grid-localizing system (Biopsy Positioning Device, model MR-BI-160, MRI Devices) or a slightly modified design of the commercially available model. This study was performed to evaluate a new method for performing MRI-guided vacuum-assisted breast biopsy in a study of lesions that had subsequent surgical excision. Fast MRI-Guided Vacuum-Assisted Breast Biopsy: Initial Experience. The Journal Impact Quartile of American Journal of Roentgenology is Q1 . Outcome of MRI-Guided Breast Biopsy, Original Research. The current editor-in-chief is Thomas H. Berquist. Directed sonography failed to show a sonographic correlate to the MRI findings in 14 of the 20 women. 1A) by one of three attending radiologists specializing in breast imaging. Breast MRI can detect cancer that is mammographically and clinically occult. MRI-guided biopsy was performed with a vacuum-assisted probe, followed by placement of a localizing clip, and then needle localization for surgical excision. The median maximal distance from the clip to the localizing wire was 0.6 cm (range, 0.1–4.1 cm). At our institution, the main indications for breast MRI are screening of women who are at high risk for breast cancer, assessment of disease extent in women with known breast cancer, and problem solving. Vacuum-assisted biopsy was successfully performed in 19 (95%) of the 20 women. Perhaps use of a clip with more artifact or using different pulse sequences would help to assess clip location on MRI. 1976. The ability to position the vacuum-assisted biopsy device adjacent to the lesion and still acquire tissue from the lesion is another advantage of vacuum-assisted biopsy over automated core biopsy . Placement of a localizing clip, attempted in 26 lesions, was successful in 96% and was within 1.1 cm of the lesion site in 88%. In the remaining six women, directed sonography was not performed at the discretion of the interpreting radiologist and treating clinician. Biopsy of lesions detected only on MRI is most often performed with MRI-guided needle localization for surgical biopsy. Among these eight cancers, five were infiltrating cancer (infiltrating ductal in two, infiltrating ductal and lobular in two, and infiltrating lobular in one) and three were ductal carcinoma in situ (DCIS). MRI-Guided Breast Biopsy: Influence of Choice of Vacuum Biopsy System on the Mode of Biopsy of MRI-Only Suspicious Breast Lesions, Technical Innovation. MRI-guided vacuum-assisted breast biopsy, which has been successfully performed in more than 500 lesions in Europe , was recently approved for use in the United States. The goal of the ARRS is maintained through an annual scientific and educational meeting and through publication of the American Journal of Roentgenology, … 10.2214/ajr.184.6.01841782. Monthly. A leading journal selection tool is available free of charge for authors to find the best fit for their manuscript. Histologic underestimation was observed in one lesion. American Journal of Roentgenology is a peer-reviewed scientific journal. 1B). Vacuum-assisted biopsy and surgical histology are correlated in Table 1. The radiologist performing the biopsy reviewed MRIs obtained during and after biopsy to determine the presence and extent of postbiopsy changes (e.g., hematoma or air); to assess whether the MRI target was sampled or possibly excised; and to evaluate whether the localizing clip was visible, noting any problems with visualization of the clip. Keywords: abbreviated, breast, cancer, MRI. The Journal Impact of an academic journal is a scientometric Metric that reflects the yearly … After the biopsy device was placed, the time of each round of tissue acquisition was determined, in seconds, by calculating the interval between stepping on the foot pedal to begin to acquire tissue and releasing the foot pedal at the completion of tissue acquisition, including any interval injection of anesthesia. A paper written by the team describing the new technology is to be published in the American Journal of Roentgenology. Time of acquisition, usually less than 1 min, varied with breast size and area covered. The obturator was not placed inside the patient at this point, but rather measured to determine where to set the depth stop (Fig. MRI-guided breast biopsy is a challenging endeavor because of the requirement for specific MRI-compatible equipment, the need to remove the patient from the magnet to perform the biopsy, limited access to the medial and posterior breast, decreasing lesion conspicuity during the procedure (the “vanishing” target), needle artifact obscuring the lesion site, desirability of placing a localizing clip, and limitations in confirming lesion retrieval . In published series of lesions that had MRI-guided needle localization and surgical biopsy, technical success rate was 98–100%; histologic analysis revealed cancer in 31–73% (of which up to half were DCIS) and high-risk lesions such as atypical ductal hyperplasia or LCIS in up to 29% [4, 9–18]. When the biopsy device was fully inserted into the white introducer, the center of the mouth was positioned where the tip of the obturator had been. The results, published in the American Journal of Roentgenology, found no significant differences in the radiologists' evaluations. Underestimates have been encountered with every existing percutaneous biopsy method. The scope of American Journal of Roentgenology covers Medicine (miscellaneous) (Q1), Radiology, Nuclear Medicine and Imaging (Q1). While the postexamination images were being acquired, the technologist retrieved the samples from the collecting chamber and placed them in formalin. For MRI-detected lesions that can be seen on sonography, biopsy can be performed under sonographic guidance. The four screening-detected cancers were in two women: one woman with bilateral breast cancer and one woman with multifocal invasive breast cancer. MRI review suggests that the MRI target may have been excised and that the microscopic DCIS in the surgical specimen was occult at MRI (Fig. Surgical histologic analysis showed fibroadenoma, other benign findings, and biopsy site changes. The study focused specifically on knee scans, and we are now working to extend the results to other parts of the body. Deep learning (DL) image reconstruction has the potential to disrupt the current state of MRI by significantly decreasing the time required for MRI examinations. A skin nick was made with a scalpel. A complication was encountered in one (4%) of 27 lesions and in one (5%) of 19 patients. One false-negative case occurred in a woman with Paget's disease. A second lesion became increasingly hyperintense on delayed images and underwent MRI-guided needle localization without biopsy during the same procedure, yielding another fibroadenoma and stromal fibrosis at surgery. We found that the clip produced such little artifact on MRI that it was sometimes difficult to distinguish from low-signal foci of air introduced during the biopsy. The diagnosis of atypical ductal hyperplasia at percutaneous biopsy is an indication for surgical excision . Publication End Year. 1G). Previous studies have shown that the likelihood of undergoing a single therapeutic operation is significantly higher in women with cancers diagnosed by percutaneous biopsy rather than surgical biopsy . MRI-guided vacuum-assisted biopsy can be performed quickly. The 9-gauge biopsy device used in this study is larger than the 11-gauge systems most commonly used for stereotactic biopsy. Biopsy of suspicious MRI-detected lesions is necessary for definitive diagnosis. False-negative results are a potential problem during any biopsy: reported false-negative rates are 0–8% for stereotactic 14-gauge automated core biopsy, 3% for stereotactic 11-gauge vacuum-assisted biopsy, and 0–8% for needle localization and surgical biopsy [38, 39]. 1F). MRI sequences performed after completion of tissue acquisition were reviewed for 26 lesions; in one lesion these images were not available because of magnet malfunction. The current editor-in-chief (August 2020) is Andrew B. Rosenkrantz. The faster the biopsy is accomplished, the less likely that the lesion will move. 2A, 2B, 2C, 2D, 2E, 2F, 2G, 2H, 2I), including one lesion that yielded benign findings at vacuum-assisted biopsy and a microscopic focus of atypical ductal hyperplasia at surgery. The median size of 27 MRI-detected lesions that had biopsy was 1.0 cm (range, 0.4–6.4 cm). The American journal of roentgenology, radium therapy, and nuclear medicine Abbreviation : Am J Roentgenol Radium Ther Nucl Med ISSN : 0002-9580 (Print) 0002-9580 (Linking) Musculoskeletal radiologists reviewed two sets of knee MRIs from 108 patients, one set using the standard imaging techniques, and one set using the fastMRI AI model. Cancer was found in eight (30%) of 27 lesions and in six (32%) of 19 women, based on review of vacuum-assisted biopsy and surgical histology. The depth of the lesion from the skin surface in millimeters (z) was calculated by determining the number of sagittal slices between the skin and the lesion and multiplying by 3 (to account for the 3-mm slice thickness). They radiologists found the … Determining lesion location and desired depth of probe insertion.—After images were reviewed at the console, a cursor was placed over the lesion on the monitor. The clear obturator was then removed from the white introducer, and the sharp stylet was placed inside the white introducer as far as it could go (Fig. The study shows that fastMRI can generate “diagnostically interchangeable” MRI images of knee injuries while using about 75 percent less raw data from the … This procedure helped to ensure that the biopsy device entered through the incision site, even when that site was later obscured by the needle guide. Our anecdotal impression is that turning the biopsy device so that it faces downward (6-o'clock position) during clip deployment, removing the clip's introducer after clip deployment, and then removing and inspecting the biopsy handpiece to ensure that the clip deployed were helpful. A beep was heard each time a specimen was acquired. Articles in this collection are free and open access. The mammogram obtained after biopsy confirmed a 3-cm soft-tissue mass with air, consistent with the clinically evident hematoma. In the interchangeability study, which was published in the American Journal of Roentgenology, radiologists reviewed both traditional MRIs and images generated with an AI model from about 75 percent less raw data. The obturator was identified on MRI as a low-signal focus measuring a median of 0.3 cm (range, 0.2–0.6 cm) in width. The median size of these 27 lesions was 1.0 cm (range, 0.4–6.4 cm). In our initial experience with a new method, the technical success rate of MRI-guided vacuum-assisted biopsy was 95%. One complication was encountered, a hematoma that resolved with compression. For more than 100 years the AJR has been recognized as one of the best specialty journals in the world. We injected a generous wheal of anesthetic to increase breast thickness. Continued by AJR, American journal of roentgenology Title varies: 1906-Sept. 1913, American quarterly of roentgenology; Nov. 1913-1922, The American journal of roentgenology; 1923-51, The American journal of roentgenology and radium therapy 14 Addeddate 2009-09-28 23:30:49 Call number AAX-2787 Camera The tray with the stylet was removed from the room before MRI was performed. Predictors for Failing the American Board of Radiology Core Examination Gary Lloyd Horn , Stephen Herrmann , Irfan Masood , Clark R. Andersen , Quan Dang Nguyen American Journal of Roentgenology . Four of eight cancers were identified in women undergoing MRI for the assessment of disease extent (multifocal cancer in the ipsilateral breast in two, multicentric cancer in the ipsilateral breast in one, and contralateral cancer in one), and four were detected in women who are at high-risk for breast cancer undergoing MRI for screening. The distance from the clip to the localizing wire was 1 cm or less in 19 (76%) of 25 lesions, 1.1 cm in three lesions (12%), and greater than 3 cm in three lesions (12%). The American Roentgen Ray Society, founded in 1900, is the first and oldest radiology society in the United States. One woman at high risk for breast cancer who was 19 years old did not have a mammogram; in the remaining 19 women, mammographic parenchymal density  was class 4 (dense) in one, class 3 (heterogeneously dense) in 14, and class 2 (scattered fibroglandular densities) in four. Faktor dampak atau faktor pengaruh atau faktor dampak jurnal dari suatu jurnal akademik adalah ukuran yang mencerminkan jumlah rata-rata sitiran (sitasi) tahunan untuk artikel terbaru yang dipublikasikan … In our practice, breast MRI examinations were interpreted by breast imaging specialists in conjunction with clinical history and other breast imaging studies, including mammograms and sonograms when available, using previously described criteria . Van Zee 2 and Lee K. Tan 3 ... American Journal of Roentgenology. American Journal of Roentgenology with Read by QxMD. In approximately one quarter of lesions (23%), cancer was found at MRI-guided vacuum-assisted biopsy. In one (4%) of the 27 lesions, a 5.0-cm non–mass lesion sampled at vacuum-assisted biopsy, vacuum-assisted biopsy histology revealed markedly atypical ductal hyperplasia and lobular carcinoma in situ (LCIS); surgical excision showed markedly atypical ductal hyperplasia focally reaching the level of low-grade cribriform DCIS, arising in a background of florid mammary sclerosing adenosis and columnar cell changes, as well as extensive LCIS (Fig. The median age of these 20 women was 51 years (range, 19–64 years). Immobilizing the breast without excessive compression may be helpful during MRI-guided biopsy to maximize breast thickness, avoid interfering with lesion enhancement , and minimize the “accordion effect” described with clip placement . The American Journal of Roentgenology (AJR) is a monthly peer-reviewed journal that covers topics in radiology. Although no anxiolytic medication was administered IV, patients were pretreated as needed with oral benzodiazepines such as diazepam (Valium [one or two 5-mg doses], Roche Pharmaceuticals, Manatí, PR) or lorazepam (Ativan [one or two 0.5-mg doses], Wyeth-Ayerst Laboratories, Philadelphia, PA) on the morning of the procedure, as discussed with the referring clinician. Vacuum-assisted biopsy is faster, less invasive, and less expensive than surgery, and it causes no deformity . The monthly American Journal of Roentgenology is a highly respected peer-reviewed journal with a worldwide circulation of close to 25,000. The horizontal (x-axis) and vertical (y-axis) coordinates of the lesion were determined on the basis of the spatial relationship between the lesion, vitamin E marker, and grid lines. The purpose of this study was to evaluate a new method for performing MRI-guided vacuum-assisted breast biopsy in a study of lesions that had subsequent surgical excision. The median size of the MRI lesions in these eight cancers was 1.1 cm (range, 0.6–6.5 cm). 2020;214: 282-295. The stylet was placed in the incision until the white plastic introducer entered the skin (to create the tract) and was then removed. The vacuum-assisted biopsy device used in our study allows rapid acquisition of multiple specimens, deferring specimen collection until after tissue acquisition is complete. Image acquisition started after injection of contrast material and saline bolus. Citation: American Journal of Roentgenology. Preparing the probe.—The clear obturator was placed inside the white introducer, and the depth stop was set so that it was the appropriate distance from the tip of the clear obturator. 9999. American Journal of Roentgenology IF is decreased by a factor of 0.13 and approximate percentage change is -3.92% when compared to preceding year 2017, which shows a falling trend. We hypothesize that the diagnosis of cancer by MRI-guided vacuum-assisted biopsy, like diagnosis of cancer by stereotactic or sonographically guided biopsy, will expedite patient management. Alternatively, if the obturator was deep in relation to the lesion, the obturator and introducer were simply pulled back to the appropriate depth. 1D). Gadolinium Retention and Breast MRI Screening: More Harm Than Good? Update on Breast Density, Risk Estimation, and Supplemental Screening, Review. Founded in 1907, the monthly American Journal of Roentgenology (AJR) is the world’s longest continuously published general radiology journal.AJR is recognized as among the specialty’s leading peer-reviewed journals and has a worldwide circulation of close to 25,000. One complication occurred: a hematoma that resolved with compression. About AJR. For the two lesions that were posterior to the grid, the skin incisions were made as close to the lesions as possible, posteriorly within the grid, and suction was applied in the posterior direction to acquire tissue. A separate skin incision was made for each lesion that underwent biopsy. A vitamin E marker was placed over the expected lesion site (Fig. Among these 27 lesions, histology was benign at vacuum-assisted biopsy and at surgery in 19 (70%), cancer at vacuum-assisted biopsy in six (22%), atypical ductal hyperplasia at vacuum-assisted biopsy and DCIS at surgery in one (4%), and benign at vacuum-assisted biopsy with surgery showing microscopic DCIS that was occult at MRI in one (4%). Tissue was acquired by stepping on the foot pedal. Vacuum-assisted biopsy also facilitates placement of a clip that can be used for subsequent needle localization . The society has been a forum for progress in radiology since shortly after the discovery of the X ray and is dedicated to the goal of the advancement of medicine through the science of radiology and its allied sciences. The sixth cancer was a 0.7-cm mass in which the imaging target may have been excised at MRI-guided vacuum-assisted biopsy, and histologic analysis of vacuum-assisted biopsy specimens yielded infiltrating lobular carcinoma; the surgical specimen showed fibrosis and changes related to prior biopsy, with no residual carcinoma (Fig. Clip placement was attempted in 26 lesions and was successful in 25 (96%) of 26. The median number of specimens obtained per lesion was eight (range, 6–14). Before participating in this study, these three radiologists had performed an average of 99 MRI-guided needle localization procedures (range, 89–119) and an average of 335 stereotactic 11-gauge vacuum-assisted breast biopsies (range, 311–364). Section Editor's Notebook: Women's Imaging—Problem Solving in Everyday Practice. OBJECTIVE. Among these 27 lesions, histology was benign at vacuum-assisted biopsy and at surgery in 19 lesions (70%) (Fig. The control module was outside the MRI scanner; only the foot pedal and biopsy device came into the room with the magnet. These new abbreviated protocols could constitute a viable screening tool both for women at high risk of breast cancer and for those at intermediate risk with high breast density. The protocol was to obtain at least six specimens. The stylet was placed inside the introducer, advanced to the appropriate depth, and then removed, with the introducer remaining in position. Although the frequency of cancer is higher among MRI-detected lesions that have sonographic correlates as compared with those that do not (43% vs 14%, p = 0.01), suspicious MRI-detected lesions that lack sonographic correlates also warrant biopsy . Cancer was present in eight (30%) of 27 lesions and in six (32%) of 19 women; among these eight cancers, five were infiltrating and three were ductal carcinoma in situ (DCIS). American Journal of Roentgenology - Journal Metrics A twisting motion was helpful when advancing the stylet. Frequency and Cancer Yield of BI-RADS Category 3 Lesions Detected at High-Risk Screening Breast MRI, Review. The results, published in the American Journal of Roentgenology, found no significant differences in the radiologists' evaluations. Automated core biopsy requires that the needle traverse a lesion in order to sample it. Like many of the more long-lived academic publications, there have been a number of name changes over the years (see below). Postbiopsy collections of air (n = 5), fluid (n = 5), or both (n = 16) measuring a median of 1.9 cm (range, 0.6–3.2 cm) were observed on MRI in all lesions. fastMRI: An open dataset and benchmarks for accelerated MRI arXiv Code Website Accelerating Magnetic Resonance Imaging (MRI) by taking fewer measurements has the potential to reduce medical costs, minimize stress to patients and make MRI possible in applications where it is currently prohibitively slow or expensive. We found that if the lesion was close to but posterior to the grid, we could position the probe adjacent to the lesion and use the suction to acquire tissue in the posterior direction, enabling us to obtain diagnostic material. Indications for Breast MRI and MRI-Guided Needle Localization, MRI-Guided Vacuum-Assisted Biopsy Technique, Review of Mammograms Obtained After Biopsy, Correlating Vacuum-Assisted Biopsy and Surgical Histology, Original Research. Mammograms obtained after biopsy in 26 lesions showed hematoma and air in 14 lesions (54%) and air without hematoma in 10 lesions (38%); in two lesions (8%), change due to biopsy was not visible on the mammogram. For more than 100 years the AJR has been recognized as one of the best specialty journals in the world. If the obturator was superficial in relation to the lesion, the obturator was removed, leaving the introducer in place. Further work with more women is necessary, including optimization of equipment and techniques for biopsy and clip placement, potential use of long-acting contrast agents, imaging–histologic correlation, and long-term follow-up, so that we can offer women the benefits of MRI in detecting breast cancer while minimizing surgeries for lesions that are benign. In that instance, sampling of a large lesion with MRI-guided biopsy yielded markedly atypical ductal hyperplasia and LCIS, whereas subsequent surgical excision revealed DCIS. Compared with fine-needle aspiration biopsy, vacuum-assisted biopsy has a higher technical success rate and fewer inadequate specimens [11, 15, 19–21]. This index can be widely applied to the productivity and impact of a scholarly journal, individual researcher or a group of scientists, such as a department or university or country. The median time to perform vacuum-assisted biopsy of a single lesion was 35 min (mean, 35 min; range, 24–48 min). Gadopentetate dimeglumine, 0.1 mmol/L per kilogram of body weight, was injected IV as a rapid bolus injection through an indwelling IV catheter, and acquisition of sagittal images (3-mm slice thickness) started immediately after contrast injection. 1E). Since less data is required, MRI scans could run nearly 4x faster. Therefore, the desired depth of insertion of the center of the collecting area (the “mouth”) of the vacuum-assisted biopsy probe from the outer aspect of the needle guide (in millimeters) was 20 plus z, where z was the calculated depth of the lesion (in millimeters) from the skin surface. We also thank Charles Nyman and David C. Perlman for invaluable assistance. The hematoma resolved with compression and did not delay subsequent surgery. The protocol called for a two-view mammogram after localization to document the location of the localizing wire and clip, which was sent with the patient for use during surgery, and for specimen radiography to confirm retrieval of the clip. MRI-guided vacuum-assisted biopsy, pioneered by Sylvia Heywang-Kobrunner, has advantages compared with other biopsy methods for the diagnosis of MRI-detected lesions . In one (4%) of the 27 lesions, a 0.4-cm smooth mass in a woman with Paget's disease of the nipple, MRI-guided vacuum-assisted biopsy yielded fibroadenoma and stromal fibrosis; MRI after vacuum-assisted biopsy showed that the MRI target may have been excised. Data were entered into a computerized spreadsheet (Excel, Microsoft, Redmond, WA) for analysis. Twenty women scheduled for MRI-guided needle localization and surgical biopsy were prospectively entered in the study. 2005;184:1782-1787. United States. Thin breasts pose challenges for MRI-guided vacuum-assisted biopsy, as for stereotactic biopsy . The protocol for this study was approved by our institutional review board. The clip introducer was then pulled back slightly (≈2 mm), and the clip was deployed by pushing down on the handle. 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